PharmacoCheck+

Why PharmacoCheck+

Pharmacogenetics testing stands as a crucial asset in preventing ADRs (adverse drug reactions). These tests examine genetic information to anticipate an individual's response to particular medications.

This approach enables more tailored medication plans, minimizes risks associated with trial-and-error prescriptions, and ultimately reduces costs for both patients and healthcare providers.

Identify which drug may be most effective before treatment starts

PharmacoCheck+ can help clinicians choose the most effective drug for each patient, minimize the risk of adverse reactions, and reduce hospitalizations

Reduce the risk of adverse events related to certain drugs

PharmacoCheck+ can assess a patient’s risk for adverse drug reactions before they take the medication which can improve patient safety and enhance medication management.

Adjust and optimize the dose of current medications

PharmacoCheck+ can help clinicians predict the appropriate dose of medication for their patients. this allows them to create more personalized medication plans to maximize efficacy and reduce Pharmacy costs.

Improve patient care

PharmacoCheck+ results become part of a patient’s medical record, allowing physicians to make more informed decisions when prescribing medications for future medical issues.

What PharmacoCheck+ Can tell us?

PharmacoCheck+ can reveal if a person is a fast, Normal, or slow metabolizer. A person’s metabolism changes the way their body responds to medication, Including:

Toxicity

Excessive amounts of the drug accumulate in the bloodstream, resulting in ADRs.

Lack of efficacy

The bloodstream cannot absorb enough of the drug to achieve a therapeutic effect.

Hypersensitivity

Normal amounts of the drug enter the bloodstream, but even this is enough to trigger severe reactions in people with hypersensitivity of the medication.

Adverse Drug Reaction Statistics* (ADR)

- ADRs are the leading cause of morbidity and mortality in healthcare, causing approximately 100,000 deaths annually.

- More than 2 million serious ADRs occur every year

- Nursing Homes experience approximately 350,000 ADRs per year.

https://www.fda.gov/drugs/drug-interactions-labeling/preventable-adverse-drug-reactions-focus-drug-interactions

Limitations

This laboratory is regulated under the Clinical Laboratory Improvement Amendment (CLIA) of 1988 as qualified to perform high

complexity clinical testing. This test is used for clinical purposes. It should not be regarded as investigational or for research. The Analyte

Specific Reagents (ASR) used in this assay are not approved by the Food and Drug administration (FDA). FDA approval is not required

for the use of these ASRs. A normal genotype report indicates only the absence of the alleles tested above and does not imply that

other mutations are not present. Absence of a detectable gene mutation or polymorphism does not rule out the possibility that a patient

has an intermediate or poor metabolizer phenotype. This test does not detect polymorphisms other than those listed. Other

polymorphisms in the primer binding regions can affect the testing, and ultimately, the genotyping assessments made. Rare diagnostic

errors may occur due to primer site mutations. Mutations in other genes associated with drug metabolism will not be detected. Drug

metabolism may be affected by non-genetic factors. DNA testing does not replace the need for clinical and therapeutic drug monitoring.

The annotations and interpretations provided in this report are based on scientific literature and do not take into account drug-drug

interactions, medical conditions or other clinical factors that may affect medication response. Gene-drug interactions are ranked

according to guidelines, level of evidence and clinical utility. Current predicted phenotype and allele functionality may change in the future

depending on new evidence. Phenotype annotations for CYP2C9 are based on total activity scores as defined by CPIC79. The report

includes alleles of proteins involved in the metabolism of many medications. In rare cases, a variant that is not covered may be typed as

*1 or other variants. In the case of pseudogenes and mutations in the untranslated regions of genes, incorrect allele typing may occur

despite proper

Methodology

The PharmacoCheck+ Personalized Medicine Panel detects all common and many rare genetic variants with known clinical significance:

Laboratory specimens were analyzed for the indicated genes using the PharmacoCheck+ Personalized Medicine Panel. The assay is

based on the Single Nucleotide Polymorphism (SNP) genotyping analysis of genomic DNA isolated from buccal swabs. The results meet

stringent quality control metrics for DNA isolation and genotyping. SNPs are processed in an OpenArray platform. Each call has an

estimated quality value >95%, based on the autocaller algorithm in the TaqMan® Genotyper software (ThermoFisher Scientific). Copy

Number calls are accepted when confidence values are >95%. Genomic DNA is extracted from the submitted specimen and amplified by

Real-Time Polymerase Chain Reaction (qPCR) using consensus oligonucleotide primers specific for the variants listed above coupled with

labeled probes for specific detection of each SNP. Amplification SNP genotyping analysis and Copy Number Variation (for CYP2D6) is

performed using the Real-Time PCR.

Lab Disclaimer

PCHS test kits are not intended to be a single source for medical decision-making. PCHS always attempts to

obtain the patient’s medication history either from the Referring Provider and/or third-party Pharmacy Benefit Managers for its

medication review. It should be noted that the medication profile could be incomplete and is dependent upon the information provided.

Pharmacogenetics Testing and the Personalized Medicine Report should not be a substitute for the medical decision-making and treatment

plan of the Prescriber.

Turnaround time is 7-10 days

By incorporating this information into your treatment decisions, you can optimize medication regimens and enhance patient outcomes. Turnaround time is 7 -10 days.

The pharmacogenetic assay involves use of reporting software and genotype-phenotype associations. The software has not been evaluated by the Food and Drug Administration. The software, and the report generated by the software, is not intended to diagnose, treat, cure, or prevent any disease. A qualified designee within the lab uses the Software to generate and subsequently review the report. The pharmacogenetic report is one of multiple pieces of information that clinicians should consider in guiding their therapeutic choice for each patient. It remains the responsibility of the health-care provider to determine the best course of treatment for a patient.

Adherence to dose guidelines does not necessarily assure a successful medical outcome.

References

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2: Bell, G. et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 genotype and use of ondansetron and tropisetron. Clinical Pharmacology & Therapeutics 102, 213-218 (2017).

3: Birdwell, K. et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for CYP3A5 Genotype and Tacrolimus Dosing. Clinical Pharmacology & Therapeutics 98, 19-24 (2015).

4: Brown, J. et al. Clinical Pharmacogenetics Implementation Consortium Guideline for Cytochrome P450 (CYP)2D6 Genotype and Atomoxetine Therapy. Clinical Pharmacology & Therapeutics 106, 94-102 (2019).

5: CooperDeHoff, RM. et al. Clinical Pharmacogenetics Implementation Consortium Guideline for SLCO1B1, ABCG2, and CYP2C9 genotypes and StatinAssociated Musculoskeletal Symptoms. Clinical Pharmacology & Therapeutics 111, 10071021 (2022).

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8: Dutch Pharmacogenetics Working Group. Dutch Pharmacogenetics Working Group Guidelines May 2020. (2020).

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10: Gammal, RS. et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for UGT1A1 and Atazanavir Prescribing. Clinical Pharmacology & Therapeutics 99, 363-369 (2016).

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15: Hicks, J. et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Selective Serotonin Reuptake Inhibitors. Clinical Pharmacology & Therapeutics 98, 127-134 (2015).

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19: King, D. et al. Smoking cessation pharmacogenetics: analysis of varenicline and bupropion in placebo-controlled clinical trials. Neuropsychopharmacology 37, 641-650 (2012).

20: Lee, C. et al. Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2C19 Genotype and Clopidogrel Therapy: 2022 Update. Clinical Pharmacology & Therapeutics 112, 959-967 (2022).

21: Lerman, C. et al. Use of the nicotine metabolite ratio as a genetically informed biomarker of response to nicotine patch or varenicline for smoking cessation: a randomised, double-blind placebo-controlled trial. The Lancet Respiratory Medicine 3, 131-138 (2015).

22: Lima, J. et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C19 and Proton Pump Inhibitor Dosing. Clinical Pharmacology & Therapeutics (2020)

23: Lipworth, J. et al. Tailored second-line therapy in asthmatic children with the Arg(16) genotype. Clinical science 124, 521-528 (2013).

24: Martin, MA. et al. Clinical pharmacogenetics implementation consortium guidelines for HLA-B genotype and abacavir dosing. Clinical Pharmacology & Therapeutics 91, 734-738 (2012).

25: McDermott, JH. et al. Clinical Pharmacogenetics Implementation Consortium Guideline for the Use of Aminoglycosides Based on MT-RNR1 Genotype. Clinical Pharmacology & Therapeutics 111, 366-372 (2022).

26: Moriyama, B. et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for CYP2C19 and Voriconazole Therapy. Clinical Pharmacology & Therapeutics 102, 45-51 (2017).

27: Muir, A. et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for IFNL3 (IL28B) Genotype and PEG Interferon-alpha-Based Regimens. Clinical Pharmacology & Therapeutics 95, 141-146 (2014).

28: Novartis Pharmaceuticals Corporation. Promacta Product Monograph. 10 (2018).

29: Phillips, E. et al. Clinical Pharmacogenetics Implementation Consortium Guideline for HLA Genotype and Use of Carbamazepine and Oxcarbazepine: 2017 Update. Clinical Pharmacology & Therapeutics 103, 574-581 (2018).

30: Relling, M. et al. Clinical Pharmacogenetics Implementation Consortium Guideline for Thiopurine Dosing Based on TPMT and NUDT15 Genotypes: 2018 Update. Clinical Pharmacology & Therapeutics 105, 1095-1105 (2019).

31: Saito, Y. et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for human leukocyte antigen B (HLA-B) genotype and allopurinol dosing: 2015 update. Clinical Pharmacology & Therapeutics 99, 36-37 (2015).

32: Theken, K. et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C9 and Nonsteroidal Antiinflammatory Drugs. Clinical Pharmacology & Therapeutics 108, 191-200 (2020)

33: Ueta, M. et al. Independent strong association of HLAA*02:06 and HLAB*44:03 with cold medicinerelated StevensJohnson syndrome with severe mucosal involvement. Scientific Reports 4, 4862 (2014).

34: Ueta, M. et al. Transethnic study confirmed independent associations of HLAA*02:06 and HLAB*44:03 with cold medicinerelated StevensJohnson syndrome with severe ocular surface complications. Scientific Reports 4, 5981 (2014).

35: US Food and Drug Administration. Table of Pharmacogenetic Associations. (2020).

36: Vijverberg, S. et al. Arg16 ADRB2 genotype increases the risk of exacerbations in children with a reported use of beta-2 agonists: Results of the PACMAN cohort study. Pharmaceutisch Weekblad 150, 233-238 (2015).

37: Wakamatsu, T. et al. Human Leukocyte Antigen Class I Genes Associated With Stevens-Johnson Syndrome and Severe Ocular Complications Following Use of Cold Medicine in a Brazilian Population. JAMA Ophthalmology 135, 355 (2017).

38: Wechsler, M. et al. Effect of beta2-adrenergic receptor polymorphism on response to longacting beta-agonist in asthma (LARGE trial): a genotype-stratified, randomised, placebo-controlled, crossover trial. The Lancet 374, 1754-1764 (2009).

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